EP2508227B1 - Implantierbare Herzprothese zur Resynchronisation des Herzens durch biventrikuläre Stimulation, die Mittel zur inversen Herzrekonfiguration umfasst - Google Patents

Implantierbare Herzprothese zur Resynchronisation des Herzens durch biventrikuläre Stimulation, die Mittel zur inversen Herzrekonfiguration umfasst Download PDF

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EP2508227B1
EP2508227B1 EP12153644.5A EP12153644A EP2508227B1 EP 2508227 B1 EP2508227 B1 EP 2508227B1 EP 12153644 A EP12153644 A EP 12153644A EP 2508227 B1 EP2508227 B1 EP 2508227B1
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Prior art keywords
configuration
pea
stimulation
change
modified
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French (fr)
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EP2508227A1 (de
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Mélanie Heurteau
Cyrille Casset
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Sorin CRM SAS
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Sorin CRM SAS
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/36585—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by two or more physical parameters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
    • A61B5/6867—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive specially adapted to be attached or implanted in a specific body part
    • A61B5/6869—Heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/36507—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by gradient or slope of the heart potential
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
    • A61N1/3682—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions with a variable atrioventricular delay
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
    • A61N1/3684—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions for stimulating the heart at multiple sites of the ventricle or the atrium
    • A61N1/36843—Bi-ventricular stimulation
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
    • A61N1/3686—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions configured for selecting the electrode configuration on a lead
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/368—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions
    • A61N1/3688—Heart stimulators controlled by a physiological parameter, e.g. heart potential comprising more than one electrode co-operating with different heart regions configured for switching the pacing mode, e.g. from AAI to DDD
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
    • A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
    • A61B5/686—Permanently implanted devices, e.g. pacemakers, other stimulators, biochips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/3621—Heart stimulators for treating or preventing abnormally high heart rate
    • A61N1/3622—Heart stimulators for treating or preventing abnormally high heart rate comprising two or more electrodes co-operating with different heart regions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61N—ELECTROTHERAPY; MAGNETOTHERAPY; RADIATION THERAPY; ULTRASOUND THERAPY
    • A61N1/00—Electrotherapy; Circuits therefor
    • A61N1/18—Applying electric currents by contact electrodes
    • A61N1/32—Applying electric currents by contact electrodes alternating or intermittent currents
    • A61N1/36—Applying electric currents by contact electrodes alternating or intermittent currents for stimulation
    • A61N1/362—Heart stimulators
    • A61N1/365—Heart stimulators controlled by a physiological parameter, e.g. heart potential
    • A61N1/36514—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure
    • A61N1/36578—Heart stimulators controlled by a physiological parameter, e.g. heart potential controlled by a physiological quantity other than heart potential, e.g. blood pressure controlled by mechanical motion of the heart wall, e.g. measured by an accelerometer or microphone

Definitions

  • the invention relates to active implantable medical devices "as defined by Directive 90/385 / EEC of 20 June 1990 of the Council of the European Communities .
  • CTR Cardiac Resynchronization Therapy
  • BVP Bi-Ventricular Pacing
  • Such a CRT stimulator is for example disclosed in the EP 1 108 446 A1 (ELA Medical).
  • the device applies between the respective instants of stimulation of the left and right ventricles a so-called "interventricular delay” (DVV or VVD) adjusted so as to resynchronize the contraction of the two ventricles to optimize the hemodynamic state of the patient.
  • interventricular delay VV or VVD
  • a simultaneous stimulation of the two ventricles is not always optimal, because it does not necessarily lead to a synchronous contraction of the two ventricles due, on the one hand, conduction delays within the myocardium that are not the same on the right and left and may depend on multiple factors and on the other hand, the location of the left ventricular lead, depending on whether it is a probe threaded into the coronary sinus or an epicardial probe. It is therefore desirable to establish a delay between the two stimulations, and to adjust this delay to resynchronize the contraction of the ventricles and thus ensure a fine optimization of the hemodynamics.
  • DVV may be null, positive (the left ventricle is stimulated after the right ventricle), or negative (the right ventricle is stimulated after the left ventricle).
  • stimulation of a given ventricle can be performed at a single stimulation site, or simultaneously at a plurality of sites.
  • stimulation sites The physical location of the intracardiac electrodes with respect to the myocardial tissue will be referred to as "stimulation sites". These sites are chosen at the time of implantation, by appropriate positioning of the electrodes after verification of the effectiveness of the selected sites. In some cases, the multisite device has several electrodes placed in a same cavity, and a change of stimulation site in this cavity is then possible by internal switching of the device.
  • CRT devices further include a conventional "dual chamber” mode of operation in which the device monitors ventricular activity following a spontaneous atrial (sensing of an atrial depolarization P wave) or stimulated (application of an A pulse of atrial stimulation). At the same time, the device begins to count a so-called “atrioventricular delay” (AVD) delay, such that if no spontaneous ventricular (R wave) activity has been detected at the end of this delay, then the device triggers a stimulation of this ventricle (application of a V pulse).
  • ATD atrioventricular delay
  • stimulation configuration The combination of characteristics i) relating to the "stimulation sites" (physical position and / or selection of sites among several possible) and those ii) relating to the parameterization of the delays will subsequently be generally designated as "stimulation configuration". DVV and DAV.
  • the EP 1 736 203 A1 (ELA Medical) describes a technique for simple, rapid, automated and accurate assessment of the impact of different parameters of CRT therapy, including AVD and DVV delays and the choice of stimulation sites, in order to optimize hemodynamic state of the patient.
  • the device described in this document uses for this purpose the parameters related to the endocardial acceleration (EA) to determine the optimal stimulation configuration, at the time of implantation or later.
  • EA endocardial acceleration
  • the endocardial acceleration is for example measured by an accelerometer integrated in an endocavitary probe, as described for example in the EP 0 515 319 A1 (Sorin Biomedica Cardio SpA)
  • endocardial acceleration is a parameter that reflects very precisely and in real time the phenomena related to contractions and relaxations of the heart chamber, and thus provides comprehensive information on heart mechanics, both in the case of normal operation as a deficient operation.
  • the EP 1 736 203 A1 proposes to modify the current configuration and to determine for each configuration tested a performance index derived from one or more parameters relating to the PEA endocardial acceleration peak, and reflecting the efficiency of the chosen configuration.
  • the configuration finally chosen will be the one that maximizes this performance index.
  • the present invention unlike these known techniques, on the other hand is not intended to determine an optimal configuration of stimulation.
  • the invention relates to a phenomenon referred to as "cardiac remodeling", which can be defined as the set of changes in the heart in response to a pathology and which is generally associated with a worse prognosis.
  • This remodeling is manifested in the long term by an increase in the size of the left ventricle, with degradation of the ejection fraction and the regime of the intraventricular pressures due to the decrease of contractility and / or too high downstream pressures, and in fine a decrease in cardiac output resulting in serious consequences for the body by progression of heart failure.
  • the CRT therapy optimizes the contraction / relaxation cycle, with a direct benefit by facilitating the work of the heart, but without the regression of previous modifications. occurred as a result of remodeling. Moreover, in some patients there is no significant response to CRT stimulation, which therefore provides no benefit.
  • drug means including treatment with betablockers, as well as non-drug means including some surgical techniques for reconstruction of the left ventricle, or the use of certain medical devices for passive mechanical restraint or cardiac mechanical assistance.
  • the problem of the invention is to find a mode of operation of the CRT device that can effectively overcome the deleterious consequences of cardiac remodeling.
  • the basic idea of the invention is to modify very temporarily the stimulation configuration in a direction that goes against optimization of the hemodynamic parameters.
  • This maneuver is to cause an immediate change in the hemodynamic response of the myocardium to controlled stimulation and to force the heart to "react" to adapt to this non-optimal mode of stimulation with consequent improvement of contractility and, in the long run, the morphology of the heart.
  • the specific stimulation produces an inverse remodeling by slow modification (over several months) of the physiological response of the heart under this constrained stimulation.
  • the analysis of the transient response of the heart to the configuration change makes it possible to evaluate the greater or lesser reactivity of the myocardium to such and such a sudden (deliberate) change of configuration, so as to seek among several configurations that which - if applied permanently - would be the most deleterious potential.
  • the invention uses for this purpose a hemodynamic sensor such as an endocardial acceleration sensor.
  • a hemodynamic sensor such as an endocardial acceleration sensor.
  • Such a sensor is in itself known, but the information that it delivers is not used to optimize the future cardiac cycles - as in the techniques proposed by the previous devices mentioned above - but to select from various modes of applied stimulation that (or those) that will optimize the reverse remodeling of the heart muscle.
  • the analysis thus carried out will make it possible to define temporary - punctually deleterious - stimulation sequences, applicable to the myocardium in order to force the latter to make a strong adaptation allowing, in the long term, improve its response in terms of pressure, ejected volume and filling and ejection times.
  • the invention provides an implantable active medical device of the cardiac prosthesis resynchronization type by biventricular pacing, comprising: atrial and ventricular event detection means; means capable of applying pulses to sites of stimulation of the right and left ventricles; means for calculating atrioventricular delay, AVD; and means for calculating an interventricular delay, DVV.
  • the combination of stimulation sites, DAV and DVV together define a stimulation pattern.
  • the device also comprises: means for collecting an endocardial acceleration signal; means for measuring the peak-to-peak amplitude of the first peak of endocardial acceleration, PEA, at each cardiac cycle; and switching means, able to change in a controlled and temporary manner the current configuration, from an original configuration to a modified configuration.
  • this device further comprises means capable of evaluating, in the modified configuration, a set of data comprising: the maximum amplitude value of the PEA reached on a first time period after the change of configuration; the average value of the PEA, calculated on a predetermined number of cardiac cycles beginning after a second period of time, of stabilization, after the change of configuration; the variability of the PEA around said average value of PEA; and the duration of a third period of time, of stabilization, after the change of configuration.
  • the invention can in particular be applied to implantable devices such as those of the Paradym CRT family produced and marketed by Sorin CRM, Clamart, France.
  • programmable microprocessor devices having circuitry for receiving, shaping, and processing electrical signals collected by implanted electrodes, and providing pacing pulses to these electrodes. It is possible to transmit by telemetry software that will be stored in memory and executed to implement some of the functions of the invention which will be described below (optimization of parameters and monitoring of the patient's condition). The adaptation of these devices to the implementation of the functions of the invention is within the abilities of those skilled in the art, and it will not be described in detail.
  • the technique of the invention is based on the analysis of the endocardial acceleration (hereinafter referred to as "EA"), which is a parameter that reflects very precisely and in real time the phenomena contributing to the mechanical functioning of the myocardium and which can be measured by an accelerometer coupled to the heart muscle, as described for example in the EP 0 515 319 A1 (Sorin Biomedica Cardio SpA).
  • EA endocardial acceleration
  • the invention is also applicable to an analysis performed from an EA signal delivered by other types of implanted sensors, such as a motion sensor of a myocardial wall, an epicardial sensor or an accelerometer placed in the housing of an implant.
  • the invention is also applicable to the analysis of an external EA signal collected non-invasively, for example from a sensor attached to the breast of the patient at the sternum.
  • the Figure 1 illustrates the various signals characterizing the activity of the heart during a cardiac cycle, with: the profile of intracardiac pressures (P A , P VG and P OG ), a surface electrocardiogram (ECG) record, and variations endocardial acceleration signal (EA).
  • P A the profile of intracardiac pressures
  • P VG the profile of intracardiac pressures
  • ECG surface electrocardiogram
  • EA variations endocardial acceleration signal
  • the characteristic P A illustrates the variations of the aortic pressure, P VG those of the left ventricle and P OG those in the left atrium.
  • Points A to E correspond to the following phases: A) contraction of the left atrium, B) closure of the mitral valve, C) opening of the aortic valve, D) closure of the aortic valve, and E) opening of the mitral valve.
  • the ECG signal presents successively: the P wave corresponding to the depolarization of the atria, the QRS complex corresponding to the depolarization of the ventricles and the ventricular repolarization T wave.
  • the Figure 2 illustrates the variations of the signal EA over three successive cycles C1, C2, C3.
  • Start-of-cycle markers make it possible to individualize the successive cardiac cycles in the continuously collected EA signal, and to isolate EA sub-signals bounded in time and each corresponding to a duration of a single cardiac cycle.
  • these early cycle time markers can be provided by the implant itself, which, depending on the mode of operation, keeps in memory the instants of the stimulation V (visible on the trace down ECG on the Figure 2 ), or the instants of detection of the R wave, in non-stimulated mode.
  • the device measures the peak-to-peak amplitude, denoted PEA (i), of the endocardial acceleration peak EA (hereinafter "PEA") on cycle i .
  • PEA peak-to-peak amplitude
  • the Figure 3 illustrates the evolution of this measure PEA (i) over time, cycle after cycle.
  • this figure shows the variations of PEA (i) during a change of stimulation configuration, from an original configuration, noted a, to a specific modified configuration, denoted b , the configuration change being operated at cycle k .
  • stimulation configuration will be understood to mean the combination of characteristics i) relating to "stimulation sites” (physical position and / or selection of sites among several possible) and those ii) relating to the setting of DVV delays. and DAV.
  • the abrupt change in k- cycle pacing pattern will result in a physiological reaction of the myocardium, for example, as illustrated Figure 3 , an increase in the amplitude of the PEA and then a gradual stabilization of this amplitude to a slightly higher average value (in the illustrated example) than in the previous configuration a .
  • configurations b may thus provide to apply modified specific configurations (configurations b ) for 30 seconds to 1 minute, interspersed with periods of recovery (return to the configuration a base) of 1 to 3 minutes.
  • This training program can cause a reverse remodeling of the heart, beneficial in the long term.
  • Each program consists of sequences, each defined by an original configuration, a specific temporary configuration, a duration of application of this temporary configuration and a recovery time (return to the original configuration).
  • the determination of the most effective configurations, in terms of inverse remodeling, is performed according to predetermined criteria, the specific configuration selected (configuration b ) being for example that having the average amplitude A (b, a) the lowest for the highest amplitude P (b, a).
  • This choice can be made manually by the practitioner on viewing the table indicated above, or automatically from a predetermined rule that will be applied by the implant.
  • the device triggers the first programmed sequence; if the current configuration is different from the original configuration, a period of recovery is applied in fashion.
  • the device modifies the configuration, from a to b , for a programmed duration.
  • the signal EA is recorded over this period, so as to determine the data ⁇ P, A, T, V ⁇ characterizing the configuration transition.
  • the unit At the end of the programmed time, the unit returns to the original configuration a , for a prescribed recovery time.
  • the device triggers either the following sequence, or returns to its standard operating mode until the next training phase (eg overnight).
  • the signal EA is recorded on all the sequences and when the training is finished (end of all the sequences), the corresponding data are stored in the implant and / or transmitted to an external programmer.
  • rhythm and activity configuration for example: daily measurement, night, activity sensor indicating rest of the patient, and heart rate between the base frequency and 110% of the base frequency. This data will allow the practitioner to monitor the impact of the training on the heart and evaluate the effectiveness of each training sequence programmed on the desired reverse remodeling.

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Claims (8)

  1. Aktive implantierbare medizinische Vorrichtung nach Art einer Herzprothese zur Resynchronisation durch biventrikuläre Stimulation, umfassend:
    - Mittel zum Erkennen von atrialen und ventrikulären Ereignissen;
    - Mittel, die geeignet sind, um Impulse an Stimulationsorten der rechten und linken Herzkammern anzulegen;
    - Mittel zum Berechnen einer atrioventrikulären Verzögerung, DAV;
    - Mittel zum Berechnen einer interventrikulären
    Verzögerung, DVV;
    wobei die Kombination der Stimulationsorte der DAV und der DVV zusammen eine Stimulationskonfiguration definieren,
    - Mittel zum Sammeln eines endokardialen Beschleunigungssignals (EA);
    - Mittel zum Messen der Doppelamplitude (PEA(i)) der ersten endokardialen Beschleunigungsspitze, PEA, in jedem Herzzyklus (i); und
    - Schaltmittel, die geeignet sind, um auf geregelte und vorübergehende Art und Weise die aktuelle Konfiguration von einer ursprünglichen Konfiguration (a) in eine geänderte Konfiguration (b) zu ändern,
    dadurch gekennzeichnet, dass sie ferner Folgendes umfasst:
    - Mittel die geeignet sind, um in der geänderten Konfiguration eine Datenmenge auszuwerten, die Folgendes umfasst:
    · den maximalen Amplitudenwert (P(b,a)) der PEA, der in einem ersten Zeitraum nach der Konfigurationsänderung erreicht wird;
    · den Mittelwert (A(b,a)) der PEA, der über eine vorbestimmte Anzahl von Herzzyklen berechnet wird, die nach einem zweiten Stabilisierungszeitraum nach der Konfigurationsänderung beginnen;
    · die Variabilität (V(b,a)) der PEA um den PEA-Mittelwert; und
    · die Dauer (T(b,a)) eines dritten Stabilisierungszeitraums nach der Konfigurationsänderung.
  2. Vorrichtung nach Anspruch 1, ferner umfassend:
    - Sequenzierungsmittel, um abwechselnd Stimulationssequenzen gemäß unterschiedlichen Konfigurationen während vorbestimmten Zeiträumen zwischen der ursprünglichen Konfiguration und einer geänderten Konfiguration, die aus einer Vielzahl möglicher unterschiedlicher geänderter Konfigurationen gewählt wird, anzuwenden, wobei die geänderte Konfiguration bei jedem Wechsel geändert wird.
  3. Vorrichtung nach Anspruch 2, wobei die Sequenzierungsmittel geeignet sind, um nach jeder Anwendung einer geänderten Konfiguration und Rückkehr zur ursprünglichen Konfiguration, diese ursprüngliche Konfiguration während einer vorbestimmten Wiederherstellungsdauer beizubehalten.
  4. Vorrichtung nach Anspruch 1, ferner umfassend:
    - Mittel, die geeignet sind, um eine Tabelle mit zwei Eingaben zu bilden, welche die Datenmenge ergibt, die für jedes nacheinander angewendete Paar {ursprüngliche Konfiguration, geänderte Konfiguration} bewertet wird.
  5. Vorrichtung nach Anspruch 1, ferner umfassend:
    - Mittel zum Bezeichnen einer repräsentativen Konfiguration der maximalen Reaktion des Herzmuskels auf die Konfigurationsänderung.
  6. Vorrichtung nach Anspruch 5, wobei die Mittel zum Bezeichnen einer repräsentativen Konfiguration Mittel sind, die geeignet sind, um die Konfiguration zu bezeichnen, die den Mittelwert der PEA im Verhältnis zum maximalen Amplitudenwert der PEA minimiert.
  7. Vorrichtung nach Anspruch 1, umfassend Mittel zum Bewerten der Dauer des dritten Stabilisierungszeitraums nach der Konfigurationsänderung durch Suchen der Dauer, die notwendig ist, damit ein kurzfristiger Mittelwert der PEA gleich einem langfristigen Mittelwert der PEA ist, bis auf eine vorbestimmte zulässige Abweichung.
  8. Vorrichtung nach Anspruch 1, umfassend Mittel zum Bewerten der Variabilität der PEA um den PEA-Mittelwert durch Berechnung einer Standardabweichung der PEA über eine vorbestimmte Anzahl aufeinanderfolgender Zyklen.
EP12153644.5A 2011-04-06 2012-02-02 Implantierbare Herzprothese zur Resynchronisation des Herzens durch biventrikuläre Stimulation, die Mittel zur inversen Herzrekonfiguration umfasst Not-in-force EP2508227B1 (de)

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EP2508227A1 EP2508227A1 (de) 2012-10-10
EP2508227B1 true EP2508227B1 (de) 2013-12-25

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EP12153644.5A Not-in-force EP2508227B1 (de) 2011-04-06 2012-02-02 Implantierbare Herzprothese zur Resynchronisation des Herzens durch biventrikuläre Stimulation, die Mittel zur inversen Herzrekonfiguration umfasst

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US9730790B2 (en) 2009-09-29 2017-08-15 Edwards Lifesciences Cardiaq Llc Replacement valve and method
US9681951B2 (en) 2013-03-14 2017-06-20 Edwards Lifesciences Cardiaq Llc Prosthesis with outer skirt and anchors
EP2839859B1 (de) * 2013-08-20 2016-04-27 Sorin CRM SAS Aktive medizinische Vorrichtung, insbesondere Einheit für kardiale Resynchronisationstherapie (CRT), die Alarmmittel zur Vorhersage einer kardialen Dekompensation im Fall einer zentralen Schlafapnoe umfasst
WO2017210047A1 (en) * 2016-06-01 2017-12-07 Cardiac Pacemakers, Inc. Methods and systems for multi-site stimulation
US10881862B2 (en) * 2017-05-10 2021-01-05 Medtronic, Inc. Estimating RV-timings from left ventricular (LV) sensing times for adaptive cardiac resynchronization therapy using DDD/VDD LV pacing without a right ventricular (RV) lead
WO2019060100A1 (en) * 2017-09-20 2019-03-28 Cardiac Pacemakers, Inc. CARDIAC INSUFFICIENCY MANAGEMENT SYSTEMS

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IT1245814B (it) 1991-05-21 1994-10-18 Sorin Biomedica Spa Dispositivo cardiostimolatore del tipo rate responsive
FR2802433B1 (fr) 1999-12-17 2002-05-17 Ela Medical Sa Dispositif medical, implantable actif, notamment stimulateur cardiaque, defibrillateur et/ou cardiovecteur du type multisite comportant des moyens de resynchronisation des ventricules
US6628988B2 (en) * 2001-04-27 2003-09-30 Cardiac Pacemakers, Inc. Apparatus and method for reversal of myocardial remodeling with electrical stimulation
US7092759B2 (en) * 2003-07-30 2006-08-15 Medtronic, Inc. Method of optimizing cardiac resynchronization therapy using sensor signals of septal wall motion
FR2873930B1 (fr) * 2004-08-04 2006-09-29 Ela Medical Sa Dispositif medical implantable actif comprenant un mode de resynchronisation des contractions ventriculaires pour le traitement de l'insuffisance cardiaque
FR2887460A1 (fr) 2005-06-22 2006-12-29 Ela Medical Soc Par Actions Si Dispositif medical implantable actif a stimulation biventriculaire et optimisation automatique de la configuration de stimulation
US7653437B2 (en) * 2006-01-31 2010-01-26 Medtronic, Inc. Method and apparatus for determining optimal pacing therapy timing intervals
EP1867360B1 (de) * 2006-06-15 2009-02-11 Ela Medical Aktives medizinisches Implantat, insbesondere Vorrichtung zur Stimulation, Resynchronisation, Defibrillation und/oder Kardioversion, die Mittel zur prädiktiven Warnung über eine Verschlimmerung des Krankheitszustands des Patienten umfasst
DE602008004206D1 (de) 2007-12-13 2011-02-10 Ela Medical Sa Medizinische Vorrichtung zur Bestimmung des Herzzustands eines Patienten, dem ein aktives Implantat zur biventrikulären Stimulation eingesetzt wurde

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US9498630B2 (en) 2016-11-22
EP2508227A1 (de) 2012-10-10
US20140336720A1 (en) 2014-11-13
US8798771B2 (en) 2014-08-05
US20120259379A1 (en) 2012-10-11

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